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1.
PLoS One ; 17(2): e0263498, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35130320

RESUMEN

Shared medical appointments (SMAs) offer a means for providing knowledge and skills needed for chronic disease management to patients. However, SMAs require a time and attention investment from health care providers, who must understand the goals and potential benefits of SMAs from the perspective of patients and providers. To better understand how to gain provider engagement and inform future SMA implementation, qualitative inquiry of provider experience based on a knowledge-attitude-practice model was explored. Semi-structured interviews were conducted with 24 health care providers leading SMAs for heart failure at three Veterans Administration Medical Centers. Rapid matrix analysis process techniques including team-based qualitative inquiry followed by stakeholder validation was employed. The interview guide followed a knowledge-attitude-practice model with a priori domains of knowledge of SMA structure and content (understanding of how SMAs were structured), SMA attitude/beliefs (general expectations about SMA use), attitudes regarding how leading SMAs affected patients, and providers. Data regarding the patient referral process (organizational processes for referring patients to SMAs) and suggested improvements were collected to further inform the development of SMA implementation best practices. Providers from all three sites reported similar knowledge, attitude and beliefs of SMAs. In general, providers reported that the multi-disciplinary structure of SMAs was an effective strategy towards improving clinical outcomes for patients. Emergent themes regarding experiences with SMAs included improved self-efficacy gained from real-time collaboration with providers from multiple disciplines, perceived decrease in patient re-hospitalizations, and promotion of self-management skills for patients with HF. Most providers reported that the SMA-setting facilitated patient learning by providing opportunities for the sharing of experiences and knowledge. This was associated with the perception of increased comradery and support among patients. Future research is needed to test suggested improvements and to develop best practices for training additional sites to implement HF SMA.


Asunto(s)
Personal de Salud , Insuficiencia Cardíaca/terapia , Citas Médicas Compartidas , Adulto , Citas y Horarios , Actitud del Personal de Salud , Femenino , Procesos de Grupo , Personal de Salud/organización & administración , Personal de Salud/psicología , Humanos , Entrevistas como Asunto , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Percepción , Atención Primaria de Salud/métodos , Atención Primaria de Salud/organización & administración , Investigación Cualitativa , Encuestas y Cuestionarios , Estados Unidos , Adulto Joven
3.
J Nurs Care Qual ; 37(1): 14-20, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-34446664

RESUMEN

BACKGROUND: Percutaneous injuries from needlesticks are a major occupational hazard for nurses. LOCAL PROBLEM: Reducing subcutaneous insulin-related needlestick injuries was part of a nurse-led comprehensive sharps injury-reduction program at an integrated, not-for-profit health system. METHODS: The incident rate of needlestick injuries was compared between 1 year before and 1 year after introducing this quality improvement project. INTERVENTIONS: A system-wide educational program instituting changes in subcutaneous insulin administration practices was combined with supply chain standardization using a single type of safety-engineered insulin syringe. RESULTS: The average monthly incidence of needlestick injuries per 10 000 subcutaneous insulin injections fell significantly from year to year (incidence rate ratio, 0.49; 95% CI, 0.30-0.80; Poisson regression P = .004). One-year cost savings for supplies totaled $3500; additional annual median savings were $24 875 (2019 US dollars) in estimated costs of needlestick injuries averted. CONCLUSIONS: The effectiveness of this multifaceted project provides a practical template to reduce subcutaneous insulin-related needlestick injuries.


Asunto(s)
Lesiones por Pinchazo de Aguja , Humanos , Incidencia , Insulina , Lesiones por Pinchazo de Aguja/epidemiología , Lesiones por Pinchazo de Aguja/prevención & control , Rol de la Enfermera , Mejoramiento de la Calidad
5.
J Transcult Nurs ; 32(4): 405-411, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-32772898

RESUMEN

INTRODUCTION: The aim of this article is to describe the modification of an instrument to secure cultural validity using cognitive interviewing to adequately examine and address health issues in a diverse population. METHOD: Cultural experts (n = 8) on the Lakota reservation were identified to provide input on cultural items of an instrument. Two rounds of cognitive interviewing ensued with each expert. The instrument items (n = 40) were reviewed and revised as indicated. RESULTS: The results of this project were twofold; a culturally valid instrument was developed, and a process was delineated to ensure cultural validity. Content validity was supported by the 100% consensus among the Lakota cultural experts on every item. DISCUSSION: This article describes how cognitive interviewing was applied for instrument modification to obtain cultural validity resulting in a relevant instrument which may useful to researchers when working with diverse populations that have unique needs.


Asunto(s)
Infecciones por Papillomavirus , Femenino , Humanos , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
6.
Nurse Educ ; 45(6): 326-330, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31972841

RESUMEN

BACKGROUND: A treatment gap exists for people in the community with opioid use disorders (OUDs). Stigma and lack of knowledge of how to access community resources contribute to this gap. One valuable resource that may help fill this gap is nursing students. PURPOSE: This study examined the impact of an educational video on prelicensure and postlicensure nursing students' knowledge and attitudes toward people with OUD. METHODS: A pre-post study design was used to examine whether 406 nursing students' knowledge and attitudes changed after viewing an educational video. Knowledge and attitudes were measured by an online survey, consisting of demographics, an 8-item Knowledge and Attitudes survey, and the Drug and Drug Problems Perceptions Questionnaire. RESULTS: The educational video produced a statistically significant positive improvement on nursing students' knowledge and attitudes. CONCLUSION: Educating nursing students about OUD and treatment options can help reduce stigma and improve care toward people with OUD.


Asunto(s)
Educación en Enfermería , Trastornos Relacionados con Opioides , Estudiantes de Enfermería , Grabación de Cinta de Video , Educación en Enfermería/métodos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Investigación en Educación de Enfermería , Trastornos Relacionados con Opioides/terapia , Encuestas y Cuestionarios , Grabación de Cinta de Video/normas
8.
Contemp Clin Trials ; 71: 140-145, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29940335

RESUMEN

A primary goal of this research project is to better understand how shared medical appointments (SMAs) can improve the health status and decrease hospitalization and death for patients recently discharged with heart failure (HF) by providing education, disease state monitoring, medication titration, and social support to patients and their caregivers. We propose a 3-site randomized-controlled efficacy trial with mixed methods to test a SMA intervention, versus usual care. Patients within 12 weeks of a HF hospitalization will be randomized to receive either HF-SMA (intervention arm) with optional co-participation with their caregivers, versus usual care (control arm). The HF-SMA will be provided by a non-physician team composed of a nurse, a nutritionist, a health psychologist, a nurse practitioner and/or a clinical pharmacist and will consist of four sessions of 2-h duration that occur every other week for 8 weeks. Each session will start with an assessment of patient needs followed by theme-based disease self-management education, followed by patient-initiated disease management discussion, and conclude with break-out sessions of individualized disease monitoring and medication case management. The study duration will be 180 days for all patients from the day of randomization. The primary study hypothesis is that, compared with usual care, patients randomized to HF-SMA will experience better cardiac health status at 90 and 180 days follow-up. The secondary hypotheses are that, compared to usual care, patients randomized to HF-SMA will experience better overall health status, a combined endpoint of hospitalization and death, better HF self-care behavior, and lower B-type natriuretic peptide levels.


Asunto(s)
Citas y Horarios , Estructura de Grupo , Insuficiencia Cardíaca , Alta del Paciente , Educación del Paciente como Asunto , Autocuidado , Apoyo Social , Femenino , Disparidades en el Estado de Salud , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/psicología , Insuficiencia Cardíaca/terapia , Hospitalización , Humanos , Masculino , Administración del Tratamiento Farmacológico , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Gravedad del Paciente , Participación del Paciente , Autocuidado/métodos , Autocuidado/psicología , Análisis de Supervivencia
9.
Prog Cardiovasc Dis ; 60(2): 249-258, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28826670

RESUMEN

OBJECTIVE: To perform a pilot evaluation of a pharmacist-led, multidisciplinary transitional care clinic for heart failure (HF) patients. BACKGROUND: Transitions of care in HF should include: medication reconciliation, multidisciplinary care, early post-discharge follow-up, and prompt intervention on HF signs and symptoms. We hypothesized that combining these elements with optimization of medications would impact outcomes. METHODS: In the SERIOUS HF Medication Reconciliation Transitional Care Clinic (HF MRTCC), patients were seen by a clinical pharmacist trained in HF. The pharmacist performed medication reconciliation, a basic physical exam, and a HF symptom history. Medications were adjusted by the clinical pharmacist or medical provider. Data were retrospectively collected for a quality improvement evaluation of this novel clinic on medication discrepancies, medications optimized, and 30-day readmissions. Descriptive statistics and paired t-tests were used for medication doses. RESULTS: All patients (n=135) had a diagnosis of HF, 59% were recently discharged. The mean time from discharge to the clinic appointment was 10±6days, and the 30day all-cause readmission rate was 9%. Medication discrepancies were detected in 53% of patients. Medications were optimized in 70%, most frequently beta blockers, ace inhibitors, and diuretics. In patients with an ejection fraction ≤40%, significantly higher doses of beta blockers and ace inhibitors were prescribed after the clinic visit. CONCLUSION: The HF MRTCC identified and corrected numerous medication discrepancies, up-titrated medications, and was associated with a 30-day readmission rate of 9%. These encouraging pilot results are hypothesis-generating and warrant further controlled trials.


Asunto(s)
Fármacos Cardiovasculares/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Conciliación de Medicamentos/organización & administración , Alta del Paciente , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Rol Profesional , Cuidado de Transición/organización & administración , Anciano , Anciano de 80 o más Años , Fármacos Cardiovasculares/efectos adversos , Cálculo de Dosificación de Drogas , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Prescripción Inadecuada , Liderazgo , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Examen Físico , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la Calidad/organización & administración , Indicadores de Calidad de la Atención de Salud/organización & administración , Estudios Retrospectivos , Factores de Tiempo
10.
Congest Heart Fail ; 18(5): 245-53, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22702724

RESUMEN

UNLABELLED: Whether provider education changes practice for HF has not been reported. (NHeFT)™ uses didactic and experiential training of primary care providers (PCP) to optimize treatment of HF. We randomized PCP's in the Cleveland VA clinics to training (T) vs control (C). ENDPOINTS: Primary - the number of patients with EF < 40% treated with ACEI/ARB and Beta Blocker, +/- diuretic post T vs pre T; Secondary - the number of patients with increase in ACEI/ARB or a decrease in diuretic post T vs. pre T. Of 641 patients, 216 (85 C,131 T) had EF < 40%; 188 (85%) did not meet the primary endpoint at baseline. After T, a similar proportion (64.2% C, 74.4%,T) met the endpoint at end of study (P = 0.14). The odds of a patient meeting the primary endpoint by care of a T provider, was not significantly higher than C (OR 1.496, 95% CI (0.751, 2.982)). Patients seen by T were more likely to have the diuretic dose decreased vs patients under C, without increases in ACEI or ARB (P < 0.03). Thus, a didactic program of HF plus a preceptorship changed practice modestly. Studies should address provider readiness of change and self efficacy to adhere to evidenced-based care.


Asunto(s)
Competencia Clínica , Conocimientos, Actitudes y Práctica en Salud , Insuficiencia Cardíaca/tratamiento farmacológico , Pautas de la Práctica en Medicina , Calidad de la Atención de Salud , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Intervalos de Confianza , Escolaridad , Femenino , Humanos , Masculino , Oportunidad Relativa , Estadística como Asunto
11.
J Am Acad Nurse Pract ; 21(3): 167-72, 2009 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-19302693

RESUMEN

PURPOSE: To describe the roles of nurse practitioners (NPs) in a novel model of healthcare delivery for patients with chronic disease: shared medical appointments (SMAs)/group visits based on the chronic care model (CCM). To map the specific skills of NPs to the six elements of the CCM: self-management, decision support, delivery system design, clinical information systems, community resources, and organizational support. DATA SOURCES: Case studies of three disease-specific multidisciplinary SMAs (diabetes, heart failure, and hypertension) in which NPs played a leadership role. CONCLUSIONS: NPs have multiple roles in development, implementation, and sustainability of SMAs as quality improvement interventions. Although the specific skills of NPs map out all six elements of the CCM, in our context, they had the greatest role in self-management, decision support, and delivery system design. IMPLICATIONS FOR PRACTICE: With the increasing numbers of patients with chronic illnesses, healthcare systems are increasingly challenged to provide necessary care and empower patients to participate in that care. NPs can play a key role in helping to meet these challenges.


Asunto(s)
Enfermedad Crónica/enfermería , Competencia Clínica , Comunicación Interdisciplinaria , Liderazgo , Enfermeras Practicantes/organización & administración , Evaluación en Enfermería/métodos , Grupo de Enfermería/organización & administración , Diabetes Mellitus/enfermería , Manejo de la Enfermedad , Insuficiencia Cardíaca/enfermería , Humanos , Hipertensión/enfermería , Rol de la Enfermera , Evaluación de Procesos y Resultados en Atención de Salud , Garantía de la Calidad de Atención de Salud , Estados Unidos
12.
Methods Mol Med ; 120: 127-46, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-16491599

RESUMEN

The estrogen receptor (ER) status and, to a lesser extent, progesterone receptor status have been recommended by recently published guidelines as important for routine prognostic and predictive evaluation of breast cancer. Although the clinical utility of ER status has been largely validated using biochemical ligand-binding assays such as the dextran-coated, charcoal ligand-binding assay, there has been the need to develop the ER immunocytochemical assay as a more accurate and practical alternative. In particular, ER status as determined on paraffin sections by immunocytochemical assay has been shown to be superior to the ligand-binding assay for predicting response to adjuvant endocrine therapy in breast cancer. The success of the paraffin-section assay is founded on two principles. The first relates to the advent of the heat-mediated, antigen-retrieval technique capable of restoring ER and progesterone receptor antigenicity in routinely prepared diagnostic formalin-fixed, paraffin-embedded tissue sections. The second is associated with the capacity for this substrate to provide more reliable and reproducible semiquantitative assessment of ER status in morphologically better-preserved tissue used routinely for histopathological diagnosis. The aim of this chapter is to describe the methodology currently used for optimal reproducible demonstration, scoring, and assessment of ER status in paraffin wax-embedded tissue sections in relation to the management of breast cancer in a routine or clinical-trial setting.


Asunto(s)
Neoplasias de la Mama/química , Inmunohistoquímica/métodos , Adhesión en Parafina/métodos , Receptores de Estrógenos/análisis , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Ensayos Clínicos como Asunto , Femenino , Humanos , Garantía de la Calidad de Atención de Salud , Reproducibilidad de los Resultados
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